Healthcare Provider Details

I. General information

NPI: 1457799231
Provider Name (Legal Business Name): ROUNAK BABULA RAWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BOSTON POST ROAD
MADISON CT
06443-2225
US

IV. Provider business mailing address

230 BOSTON POST ROAD
MADISON CT
06443-2225
US

V. Phone/Fax

Practice location:
  • Phone: 203-245-0496
  • Fax: 203-245-8697
Mailing address:
  • Phone: 203-245-0496
  • Fax: 203-245-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number64080
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number64080
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: